Yanhong Dong

Background: Digital health technologies (DHTs) offer opportunities to support poststroke self-management and rehabilitation, but their implementation may be hindered by mismatches between technological design, stakeholder needs, and care contexts. Synthesizing stakeholder perspectives can clarify implementation priorities and gaps in the evidence. Objective: This study aimed to synthesize stakeholders’ perceptions, experiences, and recommendations regarding DHT implementation in poststroke self-management and rehabilitation and to map the findings to the NASSS (Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability) framework. Methods: Six databases (PubMed, MEDLINE, Embase, Scopus, CINAHL, and Web of Science) were searched from inception through October 2025. Eligible studies were English-language, peer-reviewed primary studies using qualitative, quantitative, or mixed methods designs to report stakeholder perspectives on DHTs in poststroke care. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Mixed Methods Appraisal Tool (MMAT). A convergent integrated synthesis was conducted: quantitative findings were transformed into textual descriptors, combined with qualitative findings, coded inductively, and subsequently mapped deductively to NASSS domains and subdomains. Disagreements were resolved through consensus or by third-reviewer adjudication. Results: Of 15,262 records identified, 42 studies published between 2019 and 2025 were included: 24 qualitative, 8 quantitative, and 10 mixed methods studies. Patients, health care professionals, caregivers, and members of the public were represented in 32, 19, 8, and 3 studies, respectively, with some studies including multiple groups. Evidence concentrated on the condition, technology, value proposition, and adopter-system domains. Stakeholders valued personalized functions, intuitive interfaces, timely feedback, and digital support that complemented human care. Barriers included stroke-related motor, cognitive, communication, and sensory impairments; unequal digital access and literacy; caregiver demands; staff workload and training needs; and poor integration with clinical routines. Data privacy and unclear payment arrangements also raised concerns. Evidence on organizational readiness and wider-system determinants was limited, and no eligible study directly examined interaction and adaptation over time. Methodological concerns included nonresponse bias and insufficient interpretation of integrated findings in mixed methods studies. Conclusions: Stakeholder perspectives indicate that DHT implementation in poststroke care should combine accessible, personalized design with support for patients, caregivers, and health care professionals, alongside integration into clinical workflows and clear data governance and financing arrangements. The NASSS mapping identified priorities beyond usability, but current evidence does not establish sustained adoption, scale-up, or spread. Longitudinal studies in routine care are needed to evaluate adaptation and sustainability.

Stroke is a major cause of death and disability worldwide, contributing to a growing global public health burden.1,2 Following a stroke, individuals often experience a complex interplay of physical...

Background: Type 2 diabetes mellitus (T2DM) is a major modifiable risk factor for accelerated brain ageing, cognitive decline, and dementia. However, sustainable lifestyle interventions targeting cognitive health in at-risk older adult populations remain limited. This mixed-methods study evaluated the effects of a 12-week technology-blended Intensive Aerobic and Resistance Exercise Program (IAREP) on cognitive risk and related health outcomes among middle-aged and older adults with T2DM in a primary care setting in Singapore. Methods: Participants were recruited from a community polyclinic and allocated to either the intervention or usual care group. The intervention integrated face-to-face, Zoom-based, and video-recorded home exercise sessions to support accessibility and adherence. Quantitative outcomes included cognitive impairment (CI) risk, physical function, metabolic and inflammatory markers, physical activity, and self-care maintenance. Qualitative focus group discussions (FGDs) explored participant experiences following program completion. Results: Fifty-three participants completed the study (mean age 66.7 years). Compared with usual care, the intervention group demonstrated significant reductions in predicted risk of CI (F(1,51) = 4.9, p = .031, η²p = 0.088), improvements in physical function (F(1,51) = 10.6, p = .002, η²p = 0.172), and higher physical activity levels (F(1,51) = 8.3, p = .006, η²p = 0.140). Self-care maintenance also improved significantly (F(1,51) = 4.5, p = .040, η²p = 0.081). Adherence was high (88.9%). Qualitative findings highlighted enhanced motivation, social connectedness, and perceived cognitive and physical well-being. Conclusions: These findings support technology-blended exercise might be a feasible and scalable strategy for cognitive risk reduction and brain health promotion among middle-aged and older adults with T2DM, with potential translational relevance for dementia prevention in primary care and community settings. Clinical trial registration number: NCT06401733